In September of 1978 an international conference on primary health care was held in Alma-Ata, Kazakhstan. One hundred and thirty four governments and sixty-seven international organizations attended this forum which demanded global action to advance the protection and promotion of the health of people around the world (Seear, 2007). One of targets outlined within the Declaration of Alma-Ata states that, "A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life." (as cited by the World Health Organization, n.d.).
This declaration opened the door to endless new possibilities for the health of the world's population; it helped to redefine our present definition of health. Moreover, the social aspects of health were acknowledged, with very ambitious and optimistic goals being set. The most important question thirty years later, is how effective has this declaration been? Furthermore, why has it not been more effective?
At first glance, the concepts and targets stated by the declaration of Alma-Ata may have seemed at least within reach. However, nevertheless, it is obvious that the world's health has certainly not yet reached an acceptable level; in fact certain parts of the world are being nearly wiped out due to well-understood, preventable and treatable diseases. Health is simply a reflection of aspects such as a population's social and political influences, lifestyle, affluence and environment. Therefore by example, passing a law requiring children to receive certain vaccinations before they are allowed to enroll in school may in fact do nothing more than prevent a child from attending, because the law has not equated all of the factors affecting health. In this example, the child has not only not received vaccinations, but will also not receive an education, which puts them at an even greater disadvantage and more importantly likely to suffer from poor health. Thus, an effort to improve health had has in fact resulted in a compounding of the original problem.
Nevertheless, the Alma-Ata declaration has indeed resulted in some accomplishments and improvements; however simply put, it just hasn't been enough. Though it should be noted that this is not due to a lack of effort or dedication. Perhaps the goals really were too ambitious, after all, can one group (however large) sit down and plan what the entire world's health is going to look like in 13 years? Doesn't changing the world's health require the entire world's population's participation? Perhaps in the future, if the world is ever to meet again under similar circumstances it would be more beneficial to trade stories and accounts from individuals and small communities who are actually living these terrible health disparities. This would enable a piecing together of the small community based systems, thereby creating a more functional and attainable global health initiative. Thus utilizing the bottom-up approach, that recommends building policies and health reform based on the needs and goals of the target populations that such strategies are built for.
